DECREASE OF CAPSULAR OPACIFICATION WITH ADJUNCTIVE MITOMYCIN-C IN COMBINED GLAUCOMA AND CATARACT-SURGERY

Objective: The authors investigated the incidence of capsular opacific ation requiring YAG capsulotomy after primary trabeculectomy combined with phacoemulsification and implantation of all polymethylmethacrylat e intraocular lenses. Design: A prospective randomized study. Particip ants: One hundred seventy-four eyes of 174 nonselected patients with p rimary open-angle glaucoma (POAG) were randomized to either no adjunct ive mitomycin C (MMC) (control group of 93 eyes of 93 patients) or adj unctive subconjunctival MMC (MMC group of 81 eyes of 81 patients) duri ng the primary glaucoma triple procedure (PGTP). Intervention: Primary glaucoma triple procedure with and without MMC and YAG laser capsulot omy for posterior capsular opacification (PCO) was performed. Main Out come Measures: The incidences of YAG capsulotomy for PCO were compared between the control and MMC groups and also between the control group and the MMC subgroups (1 minute, 3 minutes, and 5 minutes of MMC appl ication) using Kaplan-Meier analysis with Mantel-Cox log-rank test. Co x proportional hazard regression analysis also was performed to identi fy significant factors affecting capsular opacification. Results: The control and MMC groups were similar in preoperative characteristics. H owever, the probability of PCO requiring YAG capsulotomy was significa ntly lower in the MMC group than in the control group (P = 0.004). Amo ng the MMC subgroups, MMC application for 3 minutes was most effective and significant when compared with that of the control group (P = 0.0 02). Although not as significant as the intraoperative use of MMC (P = 0.002), old age (P = 0.026) and presence of diabetes mellitus (P = 0. 035) were also identified as significant beneficial factors for decrea sing the incidence of YAG capsulotomy for PCO in Cox proportional haza rd regression analysis. Conclusion: Intraoperative subconjunctival MMC application during combined glaucoma and cataract surgery has a benef icial effect of inhibiting PCO after combined surgery in patients with POAG. Thus, after intraoperative subconjunctival application of MMC a t the concentration of 0.5 mg/ml for 3 minutes, the aqueous MMC level must have been great enough to inhibit the lens epithelial cell prolif eration to result in a long-term decrease in PCO.